Active NPI
Douglas Floyd Fackler, PA-C
- Medical Physician Assistant
- Evansville, IN
National Provider Identifier
1053402826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA00512
- Practice address
- Evansville VA Outpatient Clinic
500 E. Walnut
Evansville, IN 47713 - Phone
- (812) 465-6202
- Fax
- (812) 465-6201
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA00512 | TX | Primary |
Addresses
Primary practice location
Evansville VA Outpatient Clinic
500 E. Walnut
Evansville, IN 47713
Mailing address
143 Pennyrile Dr
Madisonville, KY 42431-9219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00512 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Care Group at Safe Harbor, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- NPI 1629471958
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053402826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "143 PENNYRILE DR",
"city": "MADISONVILLE",
"state": "KY",
"postal_code": "424319219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "EVANSVILLE VA OUTPATIENT CLINIC",
"address_2": "500 E. WALNUT",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "47713",
"telephone_number": "812-465-6202",
"fax_number": "812-465-6201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FACKLER",
"first_name": "DOUGLAS",
"middle_name": "FLOYD",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA00512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.